Congestive Heart failure

Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. As a result, the kidneys start retaining fluid in the body. Congestion occurs when the retained fluid builds up in the organs of the body. The condition is described as congestive heart failure.

In most cases, heart failure is a chronic, long-standing and on-going condition, but can develop suddenly. A person may experience heart failure because of structural changes in the walls of the heart chambers or improper functioning of valves.

Any factor that increases the workload of heart muscles is the risk factor for heart failure. Some of these causes include:

Coronary heart disease is a condition of the narrowing of arteries because of plaque build-up on vessel walls, which reduce the blood supply to the heart muscle

The "failing" heart continues to work, but not as efficiently as it should. People with heart failure cannot exert themselves because they experience shortness of breath and get tired easily.

Common symptoms of heart failure are:

Fatigue

Breathlessness and difficulty in breathing

Weight gain because of the retention of fluids

Inability to lie down flat on the bed because of fluid retention in the lungs

Swelling in the legs (oedema)

Your doctor will diagnose heart failure based on your medical history alone, but may also ask you to undergo a series of diagnostic tests.

Medical history: Medical history includes questions regarding your symptoms, personal history and family history of any heart disease.

Physical examination

Chest X-ray: A chest X-ray can show if your heart is enlarged and if you have fluid accumulation in and around your lungs.

Electrocardiogram: Electrocardiogram is done to measure the electrical activity of your heart. It provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart.

Echocardiogram: Echocardiogram is a test that uses sound waves to create a moving picture of the heart. These ultrasound images help to identify abnormalities in the heart muscle, valves and fluid that may surround the heart.

Nuclear heart scans: This test shows blood flow to the heart and any damage to the heart muscles. A radioactive dye is injected into your bloodstream and a special camera is used to see the dye and find areas of reduced blood flow.

Angiography (Cardiac Catheterisation): Angiography is a test that enables your doctor to take X-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and X-ray images are taken.

The management of heart failure includes general management, medications and surgery.

General Management

Reduction of physical activity reduces the demand on the heart

Dietary modifications: low salt and low fat diet

Losing weight if you are overweight

Quitting smoking

Alcohol restriction

Medications

The medications that may be prescribed include:

Diuretics: These agents promote salt and water excretion by the kidneys. This reduces the workload of the heart and symptoms of fluid retention. They help relieve shortness of breath and leg swelling

Vasodilating agents: They dilate the blood vessels and decrease the workload on the heart

Digoxin: Increases the ability of the heart muscle to contract properly and prevent heart arrhythmias

Cardioselective beta blockers: These agents slow down the heart rate, reduce the heart’s need for oxygen and improve the supply of blood to the heart muscle

Surgery

Left ventricular assist device: A mechanical heart pump called a left ventricular assist device (LVAD) which helps to pump blood from the heart to the rest of the body can be implanted until you have surgery or also as a long-term treatment.

Cardiac transplantation: Cardiac transplantation is the process of replacing the failing heart with a healthy donor heart. The donor heart is usually collected from a person who has been declared clinically brain dead. It is recommended in younger patients with severe heart failure and life expectancy less than 6 months.